Ambetter Essential Care: $0 Medical Deductible – HMO

Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: $45 copay
Specialist visit: $115 copay
Urgent care visit: $60 copay

SKU: 61836WA0050030 Categories: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Description

Health Care Plan Details

Network type HMO
Deductible Success

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Out-of-pocket max $9,250 per person $18,500 per family
Metal tier Expanded Bronze

Visit Copay

Primary care visit $45 copay
Specialist visit $115 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $60 copay
Emergency room $2,500 copay
Ambulance 50% coinsurance
Hospital stay (facility) $3,000 per day copay
Hospital stay (physician) No charge
Outpatient procedure (facility) 50% coinsurance
Outpatient procedure (physician) 50% coinsurance
Physical rehabilitation 50% coinsurance

Maternitowny and Pregnancy

Labor, delivery, hospital stay $3,000 copay

Pharmacy, Drugs, and Medication

Generic $3 copay
Brand $195 copay
Non-preferred Brand $250 copay after deductible
Specialty 50% after deductible

Lab Tests and Diagnostic Procedures

X-rays 50% coinsurance
Imaging (CT/PET/MRI) 50% coinsurance
Blood work $60 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $45 copay
Psychiatric hospital stay $3,000 per day copay

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/jJGjoJtKmnpfsn2KGWvGFbzK.pdf